ECT is an effective and unknown treatment in the psychiatric patients. The authors compared the clinical and cognitive effects of bifrontal electrode placement with standard bitemporal electrode placement in the treatment of patient with major depression disorder and bipolar mood disorder.

Twenty -five patients with major depression disorder and Twenty-one patients with bipolar mood disorder were treated with a cource of bifrontal or bitemporal ECT. The Beck Rating Scale for depression and the Yung test for bipolar and the standardized Mini-Mental State Examination were adminestered at baseline and repeated during the cource of treatment (After 6th ECT& 1mouth later).

Forty-six of the 47 patients who completed the course of treatment met remission criteria by the 6th treatment. There were no differences between the patient given bifrontal ECT and those given bitemporal ECT in the number of treatment required to reach remission criteria. The standardized Mini-Mental State score of the patient given bitemporal ECT was simillar to those of the patient given bifrontal ECT. The result of Yung test and Beck test was similar in two BT&BF groups.

Bifrontal electrode placement was as efficacious as bitemporal electrode placement and resulted the same cognitive impairment. A study of the two placements with more cognitine measures is indicated.

To compare response, remission and switch (to other pulse width and/or electrode placement) rates and number of treatments between groups receiving right unilateral ultra-brief (RUL-UB), Bitemporal brief (BT), Bifrontal Brief (BF) and Right unilateral brief (RUL-B).

Data was collected from case notes in three centers. There were 133 in total, grouped as RUL-UB (50), BT (43), BF (23), RUL-B (17). Two of the three centers had a preferred electrode placement and pulse width.

Apart from age, the groups did not differ significantly on sex distribution, proportion of bipolar depression and psychotic symptoms. 56% of patients in RUL-UB switched compared to 12.5% in RUL-B, 4.9% in BT and none in BF (p value < 0.0001). When we considered patients who switched as treatment failures, remission rates were significantly different (p value < 0.0001) 40% in RUL-UB, 81.3% in RUL-B, 73.9% in BF and 78.0% in BT. Mean number of treatments in each group was significantly different (p value < 0.0001); 12.02 in RUL-UB, 10.2 in RUL-B, 7 in BF and 7.5 in BT. Post-hoc analysis indicated that RUL-UB differed significantly from BT and BF. Final response and remission rates including patients who switched were 98% and 82% in RUL-UB, 100% and 93.8% in RUL-B, 100% and 73.9% in BF and 97.7% and 83.7% in BT.

Majority commencing RUL-UB switched and received 4–5 more treatments compared to bilateral placements. RUL-UB ECT appears less effective and might not be appropriate as first line for all older adults as some patients at higher anaesthetic risk would benefit from having reduced number of treatments.